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Society for Pediatric Radiology – Poster Archive


Pulmonary
Showing 26 Abstracts.

Park Halley,  Burgos Daylen Sire

Final Pr. ID: Poster #: CR-025

Pulmonary vein thrombosis is an exceedingly rare occurrence but should be considered in the differentials in evaluation for opacity seen on the chest radiograph, in a coagulopathic pediatric patient. Read More

Authors:  Park Halley , Burgos Daylen Sire

Keywords:  Pulmonary vein thrombosis, coagulopathic, pulmonary embolism

W Mustapha Wan Irfan

Final Pr. ID: Poster #: CR-026

Horseshoe lung is a rare congenital anomaly and is mostly accompanied by scimitar syndrome. We reported a 3 months old baby girl was initially referred from the district hospital for ventilator support for severe congenital pneumonia and dextrocardia with features suggestive of elevated pulmonary artery pressure. She was born via emergency caesar for fetal distress with moderate meconium-stained liquor. Apgar's score was 5 in 1 minute and 9 in 5 minutes. She initially required non-invasive ventilation support and was able to wean to nasal prong on day 2 of life subsequently was intubated for worsening respiratory distress on day 8 of life and was transferred to our hospital. In our hospital, she was treated for nosocomial pneumonia and ventilated for 2 days and subsequently able to extubate to nasal prong. She completed a total of 2 courses of antibiotics within 2 weeks of life. Clinically patient is not dysmorphic but in respiratory distress with sub and intercostal recession. No chest deformity. Auscultation reduced air entry over the right lung, and no murmur was heard. Echo showed situs solitus with mesocardia, dominant RA/RV, AV/VA concordant, small PFO with intact IVS, tricuspid regurgitation 3 mmHg, dilated pulmonary artery and PDA 1.2 mm bidirectional predominantly right to left. Chest radiograph showed opacified right chest, dextrocardia and enlarged left hemithorax. CT Thorax showed a tiny right pulmonary artery, the right pulmonary vein is not clear, probably draining into the IVC- RA junction and a hypoplastic right lung suggestive of scimitar syndrome with horseshoe lung complicated with pulmonary hypertension. She was kept on nasal prong oxygen since extubated because of elevated pulmonary artery pressure and respiratory distress and was given sildenafil. Horseshoe lung is rare, and most of the reported cases share the same spectrum of cardiovascular anomalies identified in scimitar syndrome, and it can be confirmed by CT and angiography. Read More

Authors:  W Mustapha Wan Irfan

Keywords:  Scimitar syndrome, horsehoe lung, pulmonary hypertension

Lacroix Caroline,  Ahyad Rayan,  Manson David

Final Pr. ID: Poster #: EDU-107

Pulmonary haemorrhage in children is a non-specific response to a number of varying insults. Many of these insults favour particular anatomic foci along the pulmonary and bronchial arterial trees respectively. Although recent years have seen an emerging interest in the understanding and classification of pulmonary vasculitides, this pathophysiology represents only one subset of the causes of pulmonary haemorrhage in children. Our purpose is to review the imaging and pathophysiologic manifestations of varying causes of pulmonary haemorrhage according to the anatomic region of susceptibilities in the pulmonary arterial and bronchial artery trees.

We aim to provide a perspective of imaging manifestations of the pathophysiologies of pulmonary haemorrhage displayed schematically according to their relative anatomic areas of susceptibility. We aim to focus on useful constellations or associated findings that will serve to help the reader differentiate amongst entities that often have otherwise similar imaging presentation.
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Authors:  Lacroix Caroline , Ahyad Rayan , Manson David

Keywords:  haemorrhage, vasculitides, anatomy, pathophysiology, pulmonary

Matos Rojas Irma,  Ugas Carlos,  Megue Huamani Marlin,  Katekaru Tokeshi Doris,  Lazarte Claudia,  Valdez Quintana Melissa,  Alpaca Rodriguez Larry,  Casamayor Alvina

Final Pr. ID: Poster #: EDU-08 (R)

The purpose of this exhibit is to review imagings findings of anomalous pulmonary venous return on angiotomography and describe anomalies associated.

Magnetic resonance (MR) imaging and computed tomography (CT) are used in diagnostic and follow – up the congenital vein anomalies. CT provides superior spatial resolution and short time but there is exposure to ionizing radiation. However in many hospital there are only the possibility of obtain CT imaging in neonates and infant.
The total anomalous pulmonary venous return (TAPVR) is the result of failure of the common pulmonary vein to connect to the left atrium with persistence of the primitive splanchnic connections of the pulmonary veins. There are four categories: supracardiac, cardiac, infracardiac and mixed.
The partial anomalous pulmonary venous return (PAPVR) occurs when some but not all segments of the developing lung failed to establish connections with the common pulmonary vein.
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Authors:  Matos Rojas Irma , Ugas Carlos , Megue Huamani Marlin , Katekaru Tokeshi Doris , Lazarte Claudia , Valdez Quintana Melissa , Alpaca Rodriguez Larry , Casamayor Alvina

Keywords:  anomalous pulmonary venous return, pulmonary veins, CT Scan

Zapala Matthew,  Zurakowski David,  Lee Edward

Final Pr. ID: Poster #: SCI-071

To compare hand versus mechanical administration of intravenous (IV) contrast on the quality of CT pulmonary angiography in the pediatric population. Read More

Authors:  Zapala Matthew , Zurakowski David , Lee Edward

Keywords:  CT, Pulmonary artery, Contrast

Prasad Preeti,  Khan Muhammad,  Maller Vijetha

Final Pr. ID: Poster #: EDU-062

Congenital anomalies of lungs are heterogenous group of developmental disorders which vary widely in their clinical manifestations, imaging appearance and pathology, but with a considerable overlap. There has been substantial improvement in our understanding of these lesions due to advances in prenatal and postnatal imaging. The purpose of this educational exhibit is to describe the radiological appearance of various congenital lung abnormalities and facilitate our fellow radiologists to accurately diagnose these anomalies and contribute to the patient management. Read More

Authors:  Prasad Preeti , Khan Muhammad , Maller Vijetha

Keywords:  pulmonary, anomalies, congenital

Hirsig Leslie,  Verma Nupur,  Sharma Priya,  Rajderkar Dhanashree

Final Pr. ID: Poster #: EDU-115

Congenital and childhood findings of pulmonary artery anomalies are uncommon but not infrequently encountered by referral centers. We present by case examples anomalies of pulmonary arterial vasculature, and discuss their clinical presentation, associated cardiothoracic anomalies, and overall prognosis. Read More

Authors:  Hirsig Leslie , Verma Nupur , Sharma Priya , Rajderkar Dhanashree

Keywords:  Pulmonary anamolies, Congenital malformations, Pulmonary Origin, Pulmonary Hypertension, Pulmonary complications

Alkhori Noor

Final Pr. ID: Poster #: EDU-061

The purpose of this educational presentation is to provide a pictorial review to promote recognition and understanding of the embryology, anatomy and spectrum of congenital pulmonary artery anomalies in children Read More

Authors:  Alkhori Noor

Keywords:  Pulmonary artery, Congenital, Pediatric

Cielma Tara,  Hill Cara,  Mirza Sobia,  Sanchez Ramon

Final Pr. ID: Poster #: EDU-004

Venous thromboembolism (VTE) is a multifactorial disease and a significant source of morbidity. Though the incidence of VTE, composed of deep venous thrombosis (DVT) and pulmonary emobolism (PE), is more common in adults, an increasing number of children are being diagnosed. Children who are critically ill are at greatest risk of developing VTE.

Duplex sonography is a critical front line tool in the detection and evaluation of venous thrombosis. Serial surveillance examinations allow real-time assessment of thrombosis including propagation and progression.

Recognizing the presentation and sonographic appearance of venous thrombosis assists the clinician in timely therapeutic decision-making and clinical management.

The goals of this exhibit are:

1. Describe the technical approach of performing duplex vascular ultrasound, including tips and technology that assist in optimizing studies.
2. Discuss the incidence, risk factors, and clinical characteristics of pediatric VTE.
3. Depict the sonographic appearance of thrombosis with emphasis on correlation to other modalities.
4. Discuss prognosis and long-term outcomes of VTE in children.
5. Describe future techniques and applications.
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Authors:  Cielma Tara , Hill Cara , Mirza Sobia , Sanchez Ramon

Keywords:  Deep venous thrombosis, Venous thromboembolism, Pulmonary embolism

Tanaka Yoshihiro,  Nakagawa Motoo,  Ozawa Yoshiyuki,  Shibamoto Yuta

Final Pr. ID: Poster #: CR-019

The case was a fetus in a 29-year-old mother (gravida 3, para 1). At 29 weeks of gestation, she was referred to our hospital due to abnormality of fetal heart sounds. On fetal MRI, the right pulmonary agenesis was suspected. A 3.5-kg baby girl was born at 41 weeks and 1 day of gestational ages by cesarean section with Apgar scores of 6 and 9 at 1 and 5 minutes respectively. Her respiratory status was stable under administration of 30% oxygen in an incubator. Read More

Authors:  Tanaka Yoshihiro , Nakagawa Motoo , Ozawa Yoshiyuki , Shibamoto Yuta

Keywords:  Horseshoe lung, pulmonary hypoplasia, pulmonary agenesis

Shah Jignesh,  Chauhan Ankita,  Sandhu Preet

Final Pr. ID: Poster #: EDU-082

1. To discuss etiologies of unilateral hyperlucent hemithorax in children.
2. To discuss radiographic and cross-sectional imaging features of various conditions leading to unilateral hyperlucent hemithorax.
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Authors:  Shah Jignesh , Chauhan Ankita , Sandhu Preet

Keywords:  Unilateral hyperlucent hemithorax, congenital lobar overinflation, congenital pulmonary airway malformation

Poletto Erica,  Fox Evan,  Malik Archana,  Geller Evan

Final Pr. ID: Poster #: CR-020

Hypertrophic pulmonary osteoarthropathy (HPOA) is a syndrome characterized by excessive proliferation of skin and bone in the distal extremities. The classic imaging finding is symmetric, smooth periosteal reaction of the bones of the forearm or lower leg. The pathogenesis of this new bone formation is not well understood. Proposed mechanisms include growth factor release mediated by the tumor itself or the shunting of megakaryocytes through the pulmonary vasculature. These growth factors may contribute to vascular proliferation and bone formation. HPOA can be idiopathic but is more commonly secondary in patients with a variety of pulmonary disorders, congenital heart disease, and inflammatory bowel disease. HPOA is more commonly seen in adults than children. We present a case of HPOA in a patient with pleuropulmonary blastoma, a rare pediatric intrathoracic tumor.


A 3 year-old girl was diagnosed with pleuropulmonary blastoma after presenting to the emergency department with a twelve-day history of fever and leg pain. As part of a fever of unknown origin workup, chest radiographs were performed, which showed a large left lower lobe mass. Contrast-enhanced computed tomography characterized the mass as mixed cystic and solid. As part of the preoperative evaluation for osseous metastatic disease, a technetium-99m bone scan was performed, which revealed bilateral, symmetric radiotracer uptake within the ulnar and fibular shafts, and the distal humeri. Subsequent radiographs of these bones demonstrated bilateral, symmetric smooth periosteal reaction. Following surgical resection of the pleuropulmonary blastoma and completion of chemotherapy, a bone scan was repeated which showed resolution of the previously seen scintigraphic findings.

To date, HPOA has never been reported in a patient with pleuropulmonary blastoma. This case report highlights that HPOA, commonly thought of as an entity of adult lung disease, can also present in children.
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Authors:  Poletto Erica , Fox Evan , Malik Archana , Geller Evan

Keywords:  Hypertrophic Pulmonary Osteoarthropathy, Pleuropulmonary Blastoma

Rapp Jordan,  Poletto Erica,  Urbine Jaqueline,  Malik Archana,  Kazmi Faaiza,  Mallon Mea

Final Pr. ID: Poster #: EDU-007

The rare entity of an absent pulmonary artery has appeared in the literature since 1868, with most cases associated with congenital heart disease of various types. It has also long been observed that the absent pulmonary artery is contralateral to the aortic arch in almost every case. Isolated absence of a single pulmonary artery without associated congenital heart disease is less common, and these patients may present at any time from prenatal screening, neonatal period, early childhood, or even adolescence and adulthood. We will discuss the embryologic origins, clinical presentations, expected imaging findings, and treatment options based on patient ages from newborn to adolescence.

In neonates with an isolated absent pulmonary artery, a patent ductus arteriosus will allow for continued systemic blood supply. Even early on, narrowing of the PDA may be seen as involution is inevitable without intervention. The lung parenchyma is typically preserved, without yet evidence of hypoplasia or oligemia. Once the PDA has closed, robust collateral formation will occur. As patients age without repair, the lung parenchyma may become hypoplastic with diminished lung volumes and vascular markings. Findings suggestive of recurrent infection such as bronchiectasis may also be evident.

Early discovery and treatment is ideal as this will allow for prevention of long term sequelae and the greatest restoration of lung function as the options for repair are limited in the older patient. There is no universal standard approach for repairing the underlying mechanism of providing blood flow to the intrapulmonary pulmonary artery. Early intervention in neonates included PDA stenting or anastomosing the main pulmonary artery with the intrapulmonary pulmonary artery using a synthetic graft. Patients that present after the neonatal period are not likely to be eligible for surgical repair. The most common long term effect of an absent pulmonary artery is pulmonary hypertension, seen in 40% of patients.

The entity of isolated unilateral absence of a pulmonary artery is rare, however demonstrates typical cardiothoracic findings depending on age at presentation. Understanding of embryology, specifically the 4th and 6th primitive aortic arches, allows one to understand why this malformation occurred and what findings to expect on imaging. The maintained PDA is vital for early lung blood supply and development and can aid in repair.
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Authors:  Rapp Jordan , Poletto Erica , Urbine Jaqueline , Malik Archana , Kazmi Faaiza , Mallon Mea

Keywords:  Pulmonary artery, congenital, CTA

Ruoss Justin,  Sharma Priya,  Rajderkar Dhanashree

Final Pr. ID: Poster #: EDU-121

In this educational exhibit we will use a series of cases from our institution to review the approach to non-mediastinal solid and solid-like lesions found in the pediatric chest. We will use a multimodality approach and discuss differentials, key imaging features and the pathologic basis of these lesions. Read More

Authors:  Ruoss Justin , Sharma Priya , Rajderkar Dhanashree

Keywords:  Chest Masses, Pulmonary Tumors, Persistent Wheezing

Wu Jennifer,  Myers Ross,  Sadowsky David,  Li Tianyang,  Tsui Edison,  Sonke Pierre-yves

Final Pr. ID: Poster #: EDU-004

Congenital heart diseases often occurs secondary to a variety of insults and rotational errors during development in utero. These can range from a spectrum of simple to more complex pathologies including arterial switches. It is important for radiologists to recognize the embryology and complications of arterial switches to further management. Today largely secondary to new advances in technology both corrected and uncorrected arterial switches are diagnosed more commonly; previously many patients with arterial switches may not have survived into adulthood.

In utero, the primitive truncus is normally positioned anterior and midline. It eventually divides into the aorta and the pulmonary artery, which then rotates clockwise 150 degrees such that the pulmonary artery lies anterior to and left of the aorta. When variations occur it can result in a congenitally corrected transposition such as L- transposition of the great arteries (L-TGA) where the two ventricles are morphologically switched in position. With L-TGA, the truncus rotates 30-degrees clockwise which results in the aorta being anterior and leftward in relation to the pulmonary artery.

In uncorrected transposition (R-TGA) the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle, secondary to a 30-degree counterclockwise rotation of the primitive truncus, the aorta is then located rightward and anterior to the pulmonary artery. This condition needs to be corrected surgically due to cyanosis resulting from the right ventricle not being able to supply the systemic circulation. Other variations of arterial switches that can occur is situs inversus where the rotation of the aorta and pulmonary artery is completely opposite of that which would be considered normal. Lastly in truncus arteriosus, the primitive truncus does not divide into a separate aorta and pulmonary artery. We will provide several cases from our institution of arterial switches on imaging as well as diagramatic representative models describing the embryology of how arterial switches and rotations occur. We also discuss the repairs and complications of these cases.
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Authors:  Wu Jennifer , Myers Ross , Sadowsky David , Li Tianyang , Tsui Edison , Sonke Pierre-yves

Keywords:  cardiac, Pulmonary

Rubio Eva,  Blask Anna,  Loomis Judyta,  Bulas Dorothy

Final Pr. ID: Poster #: SCI-042

The purpose of this study is to describe the MR and US prenatal imaging features and associated anomalies of unilateral pulmonary agenesis, as well as characterize the morbidity and mortality in postnatal life. Read More

Authors:  Rubio Eva , Blask Anna , Loomis Judyta , Bulas Dorothy

Keywords:  pulmonary, agenesis, VACTERL

Ebai Jerky,  Nicholas Jennifer,  Foust Alexandra

Final Pr. ID: Poster #: CR-023

An afebrile 23-month-old boy with history of VSD, PFO and GERD who presented with one day of acute left sided abdominal pain, nausea and vomiting. Following a benign clinical work-up only significant for mild leukocytosis and transient small bowel to small bowel intussusception on abdominal US, he was discharged home. He re-presented a few days later with worsening abdominal pain and low grade fever and was found to have increased leukocytosis and elevated CRP. KUB demonstrated a new left lower lobe opacity. Non-contrast CT abdomen showed a well circumscribed ovoid hyperdense soft tissue mass in the inferomedial left lower lobe, a small left pleural effusion, and adjacent passive atelectasis. On chest MRI , the left lower lobe soft tissue mass demonstrated T1 isointense to hyperintense and STIR hypointense signal with mild restricted diffusion and no enhancement on post-contrast images. MRA of the chest was negative for any feeding vessel extending to the lesion. Video-assisted thoracotomy surgery revealed a torsed, bluish left lower lobe mass adherent to the mediastinum with thrombosed vessels at its pedicle. Pathology results confirmed the suspected diagnosis of an infarcted and hemorrhagic extralobar pulmonary sequestration.

Pulmonary sequestration is a rare congenital malformation of the foregut, where a nonfunctional supranumary segment of the lung lacking a normal connection to the tracheobronchial tree develops below the normal lung bud. The sequestration can be intralobar or extralobar, depending on the pleural investment, has arterial supply from systemic circulation, and venous drainage via pulmonary and/or systemic venous drainage. Torsed pulmonary sequestrations are extremely rare and occur when the sequestration twists around the axis of its vascular pedicle resulting in ischemia or infarction of the non-functional lung tissue. In the case of a full torsion, the vascular supply may not be visualized at imaging. Thus it is important to consider pulmonary sequestration as a differential diagnosis in a pediatric patient presenting with lower chest or abdominal pain with a circumscribed lower lobe pulmonary mass, even without characteristic feeding vessels on MRI/MRA.
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Authors:  Ebai Jerky , Nicholas Jennifer , Foust Alexandra

Keywords:  Pulmonary, Sequestration, Torsed

Ouyang Rong-zhen,  Zhong Yumin,  Guo Chen,  Hu Li-wei

Final Pr. ID: Poster #: SCI-007

Many patients with repaired Tetralogy of Fallot (TOF) have right ventricular (RV) volume overload due to pulmonary regurgitation (PR)and would have ventricular deformation as time goes by after repaired surgery. We studied the effect of pulmonary regurgitation on global and regional right ventricular (RV) deformation, and their relationships with conventional diagnostic parameters. Read More

Authors:  Ouyang Rong-zhen , Zhong Yumin , Guo Chen , Hu Li-wei

Keywords:  tetralogy of fallot, strain, pulmonary regurgitation

Ndolo Josephine,  Crane Gabriella,  Hernanz-schulman Marta

Final Pr. ID: Poster #: CR-001

Introduction
Scimitar syndrome and subdiaphragmatic total anomalous pulmonary venous connections (TAPVC) are congenital pulmonary vascular anomalies that are not typically diagnosed on routine abdominal sonography. We present three cases of ultrasound diagnosis of neonates with subdiaphragmatic pulmonary veins diagnosed on abdominal ultrasound; to the best of our knowledge, this is the first reported case of abdominal ultrasound diagnosis of previously unknown scimitar syndrome.

Case reports
Case 1: 16 day old girl born at term with cardiac dextroposition and right lung hypoplasia. On abdominal ultrasound, a large vascular structure was seen draining into the inferior vena cava (IVC) near the hepatic confluence, arising in lung above the diaphragm. Doppler confirms venous flow into the IVC (Figure 1); an arterial aortic branch with pulmonary spectral Doppler signature, extended into the base of the right lung. The diagnosis of scimitar syndrome was made, confirmed several weeks later with CT angiography.

Case 2: One day old girl born at 29 weeks gestation had a prenatal diagnosis of complex congenital heart disease. Abdominal ultrasound demonstrated asplenia. As part of the complex, the examination demonstrated the common pulmonary vein draining into the left portal vein, decompressing into the heart via the ductus venosus, with color and spectral demonstration of flow direction and velocity. (Figure 2) Closure of the ductus venosus contributed to the demise of this child who was inoperable due to her extreme prematurity and her other congenital cardiac lesions.

Case 3: Eight day old term infant with multiple congenital anomalies. An abdominal ultrasound for heterotaxy evaluation demonstrated a large anomalous vessel arising in the chest between the descending aorta and esophagus posteriorly, and the atrium anteriorly, descending into the abdomen draining into the portal vein, with a partially obstructing membrane near the insertion point. (Figure 3). The TAPVC was repaired on day 9 of life with direct anastomosis to the left atrium.

Conclusion:
In conclusion, subdiaphragmatic vascular components of thoracic anomalies should be recognized at abdominal sonography by pediatric radiologists, who may be the first to both recognize and diagnose these conditions.
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Authors:  Ndolo Josephine , Crane Gabriella , Hernanz-schulman Marta

Keywords:  total anomalous pulmonary venous connection (TAPVC), Scimitar syndrome, ultrasound

Ehrmann Daniel,  Browne Lorna,  Fonseca Brian,  Younoszai Adel,  Dimaria Michael

Final Pr. ID: Poster #: SCI-048

Infants with one functional cardiac ventricle undergo operations that yield unobstructed systemic outflow and a controlled source of pulmonary blood flow, often starting with the Norwood operation with Blalock-Taussig (BT) shunt. Infants with shunt dependent pulmonary blood flow are at risk for developing proximal pulmonary artery (PA) stenoses, which may result in morbidity and mortality. Echocardiography (TTE) is the primary means of surveillance for PA narrowing, but is limited by acoustic windows, operator experience and patient cooperation. Computed tomography (CT) offers high spatial resolution, rapid acquisition and relatively low radiation exposure. To date, there have been no studies comparing TTE and CT-derived measurements of the proximal PA anatomy in this high-risk population. Read More

Authors:  Ehrmann Daniel , Browne Lorna , Fonseca Brian , Younoszai Adel , Dimaria Michael

Keywords:  Congenital Heart Disease, Single ventricle, Pulmonary Artery, CT, Echocardiography

Misiura Anne,  Urbine Jaqueline,  Mallon Mea,  Kazmi Faaiza,  Malik Archana,  Poletto Erica

Final Pr. ID: Poster #: EDU-009

Pulmonary sequestration comprises a spectrum of congenital lung anomalies in which one or more of the following are present: bronchial sequestration, aberrant systemic arterial supply, and/or anomalous pulmonary venous drainage. Treatment is surgical; however, evaluation of the lesion with chest computed tomography (CT) prior to surgery is vital for planning as there are different surgical interventions required based on the components of the sequestration. Sequestrations can be associated with additional congenital abnormalities, some of which can also be evaluated by chest CT prior to surgery. Read More

Authors:  Misiura Anne , Urbine Jaqueline , Mallon Mea , Kazmi Faaiza , Malik Archana , Poletto Erica

Keywords:  Pulmonary, Congential, Sequestration

Ferreira Botelho Marcos,  Greenfield Susan,  Hughes Katrina,  John Susan

Final Pr. ID: Poster #: EDU-027

Congenital bronchopulmonary malformations are frequently encountered in the routine clinical practice. The specific diagnosis of pulmonary sequestration, associated or not with congenital pulmonary airway malformations (hybrid lesion) has important treatment and prognostic values. The purpose of this exhibit is to explain the current understanding of pulmonary sequestrations and improve diagnostic accuracy among general and pediatric radiologists when describing such lesions. Read More

Authors:  Ferreira Botelho Marcos , Greenfield Susan , Hughes Katrina , John Susan

Keywords:  Pulmonary sequestration, Congenital bronchopulmoary malformation, Hybrid lesion

Di Puglia Elazir,  Fazecas Tatiana,  Penna Claudia,  Porto Miriam,  Guedes Bianca,  Waksman Maria Gabriela

Final Pr. ID: Poster #: EDU-019 (S)

- To review the ethiopathogenesis of tuberculosis (TB);
- To discuss clinical and epidemiological variables, as well the radiological findings seen in radiography, ultrasound (US), computed tomography (CT) and magnetic resonance (MR) imaging performed due to clinical suspicion of TB;
- To review and widely ilustrated in this paper the imaging findings in TB.

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Authors:  Di Puglia Elazir , Fazecas Tatiana , Penna Claudia , Porto Miriam , Guedes Bianca , Waksman Maria Gabriela

Keywords:  Tuberculosis, disseminated, pulmonary

Niakan Lillian,  Birkemeier Krista,  Santiago Jose

Final Pr. ID: Poster #: CR-033

Introduction: The use of e-cigarettes, or vaping, has become increasing popular, and little is known about its long-term effects. We present a case of vaping-associated lung illness in a pediatric patient.

Case Presentation: An 18 year-old male presented with worsening fever, chills, and vomiting over a week. He was diagnosed and treated for pneumonia. He denied smoking but endorsed vaping until developing his illness. Over the next two weeks, he lost 12-15 pounds but his cough improved and his appetite returned. He continued to feel weak, tired, and lightheaded upon standing. Labs revealed an elevated ESR and platelet count. The chest radiograph demonstrated an abnormal pattern of perihilar consolidation and ground glass opacity. Further evaluation by computed tomography demonstrated bilateral interstitial and ground glass opacities with areas of consolidation and tree-in-bud centrilobular nodules. The opacities were predominantly peripheral and peribronchiole in location with subpleural sparing. There was associated cylindrical and varicoid bronchiectasis. The overall appearance was most consistent with organizing pneumonia.

Discussion: Little is understood about the relatively new vaping-associated lung illness. E-cigarettes were first introduced in 2007, marketed as a safer alternative to smoking cigarettes and as a method for smoking cessation. Vaping has become exceedingly popular among youth. E-cigarettes use heat to vaporize liquid into aerosol, which is then inhaled. Liquid cartridges often contain nicotine, tetrahydrocannabinol, and cannabinoid oils. Additional compounds also found in these products include diacetyl and propylene glycol for flavoring and glycerin to create visible smoke. The exact mechanism and cause for lung injury is unclear, but it is postulated that chemical irritation and potentially thermal injury lead to some of the effects seen thus far. Other ingredients can be added to cartridges, making the etiology of injury even more elusive. Based on reported cases, patients often present with a range of symptoms, including dyspnea, pleuritic chest pain, nausea, and vomiting. Work-ups often reveal lipoid pneumonia, bronchiectasis, eosinophilic pneumonia, pleural effusions, suspected hypersensitivity pneumonitis, and at least one case of diffuse alveolar hemorrhage. In our case the appearance was that of organizing pneumonia. It is unclear if damage is reversible, but some reports discuss clinical improvements with a steroid course.
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Authors:  Niakan Lillian , Birkemeier Krista , Santiago Jose

Keywords:  Thoracic, Pulmonary